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General NPI Number Information
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NPI Number | 1629823208
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Entity Type | Organization
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Legal Business Name | RIVERDALE PHARMACY LLC
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 3547 JOHNSON AVE
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City | BRONX
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State | NY
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Zip | 10463-1602
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Country | US
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Telephone | 718-395-3509
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Fax | 718-395-5695
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Provider Business Mailing Address
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Address Line | 3547 JOHNSON AVE
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City | BRONX
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State | NY
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Zip | 10463-1602
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Country | US
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Telephone | 718-395-3509
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Fax | 718-395-5695
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Authorized Official
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Title or Position | OWNER/ PHARMACIST
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Name | TUSHAR BALAR
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Credential |
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Telephone | 551-998-4909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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